Keep acute surgery 24/7

23:53, Jun 01 2014
wairau hospital
VALUED: A report into medical services at the top of the south recommends 24/7 acute surgery services should be retained.

Round-the-clock acute surgical services should be retained at Wairau Hospital, a long-awaited report released yesterday recommends.

The top of the south service review looked at the provision of general medicine, orthopaedics and surgical services at Wairau and Nelson hospitals.

While acute general surgery required at Wairau was low, the Nelson Marlborough District Health Board was committed to providing 24/7 acute general surgery service, the report says.

"Loss of an elective and acute service would have far-reaching impacts on the hospital and community, and threaten other services such as obstetrics and gynaecology and anaesthesia," the report's executive summary says.

The report recommends general and acute internal medicine services provided at Wairau Hospital be maintained, however due to the small size of the team it urged the board to do succession planning for the future.

The report recognised the need to increase public confidence in Wairau Hospital surgery services following investigations into surgeries by Dr Michael Parry that resulted in two deaths.


The review, written by independent clinicians, supported the board's model of "one service, two sites". The preferred model was an integrated surgical service shared by the hospitals with both performing regular elective surgery.

Board chief executive Chris Fleming said the review was not a radical revolution of services.

"We have a very complex health system and we will have to make some tough decisions. I think the review is the best solution ..."

He said strengthening the general medical workforce, and making sure it was a flexible workforce that could work across Wairau and Nelson hospital sites, were future priorities.

It was not feasible to duplicate services on both hospital sites and Marlborough patients would have to travel to Nelson for some services where there was a higher level of infrastructure and a supporting intensive care unit.

"We will look at travel assistance and accommodation where patients and staff will need to travel."

Fleming said the challenge was to provide services as close to home as possible while using the hospital network's collective resources.

The report says the board has a growing but ageing population, particularly in Tasman, and Wairau Hospital would require increased resources.

As a result of the review there would be a greater board and management presence at Wairau Hospital to improve clinical governance. Already there have been appointments of associate medical officer, associate director and nursing/operations manager and service manager for surgical services based at Wairau.

Residents should have greater involvement in the strategic planning to understand the demands the growing, ageing population placed on the health dollar, the report recommends.

Subject to public endorsement of the review's recommendations, an investment would be required, Fleming said. He could not say how much this would be worth.

It would take about 10 years to implement all the recommendations but some would be prioritised and implemented immediately, he said.

The report said in the short term there would be no changes on how internal medicine services were delivered at Wairau Hospital.

The community rallied last year when it learnt the DHB was considering options including removing acute surgery services at Wairau Hospital or reducing them to between 8am and 4pm on weekdays. A public meeting attracted about 1000 people.


A report from the top of the south review team has provided a clear framework of what needs to be done to ensure Marlborough continues to have 24-7 hospital services, says a health board member.

Save Our Services campaigner and Nelson Marlborough District Health Board member Jessica Bagge yesterday said she was "really happy" with the report, which was better than she had expected.

It provided recommendations from a panel of clinicians on how Wairau Hospital's general, medical, surgical and orthopaedic services could be retained for the future.

" ... it's truly sympathetic to all circumstances and the people, I think it's particularly good for Wairau and it guarantees that we will have access to 24-7 care," Bagge said.

The process had forced the board to look at the state of healthcare in Marlborough, and what needed to be done to ensure the required services were retained for the future.

The findings meant the hospital could see a switch from more "specialised" surgeons, who worked in a particular field, to more "generalist surgeons", who had "subspecialist interests", and the ability to work in broader fields of surgery, Bagge said.

"We're going to challenge everybody to look at what is best for everybody at both sites ... more collaborative. Some of these things will be implemented into our annual plan for the hospital. It's about making sure that we have enough surgeons and medical staff that are able to do everything."

National Party election candidate Stuart Smith, a member of Save Our Services, said he was "very comfortable" with the report. "I believe that the review maps out a clear strategy and a pathway for the preservation of services ... as a community what we need to do now is ensure that the DHB carries out the recommendations," he said.

Despite criticism of the board in early stages of the review, it needed to be commended for getting this far, Smith said. "They need to be congratulated for taking it on the chin and putting a review panel in place."

The review panel had validated issues raised by the public, Smith said. He and Bagge both recommended Marlborough residents attend the meeting next month.

The Save Our Services group was set up after the board announced plans in January last year to review general and orthopaedic services at Wairau Hospital. The group held a well-attended public meeting on the possible cuts and sent a petition to Health Minister Tony Ryall.


General medicine

● Support one service - two site model

● Review number of registrars (currently none at Wairau)

● Greater board and management presence in Wairau


● High quality of cardiology service at Nelson acknowledged but at the cost of expertise of general surgeons at Wairau

● Support generalist surgeons with subspeciality interest

● Review distribution of subspeciality services

● Assessment units to manage acute demand

● Phase in registrars


● Will take considerable time to restore community confidence and staff morale at Wairau

● Commit to quality and safety of services at Wairau and to continuity of the hospital service

● Recognise that Wairau will be needed to meet increasing demand, although most population growth in Tasman

● Look at accommodation and transport issues between the two sites


● Recognise work in Blenheim insufficient to sustain three fulltime surgeons

● Compounded by low volume of acute work

● Implications for future recruitment helped with financial, lifestyle incentives, rotating registrars

● Greater travel for staff and patients between both hospital sites.

The Marlborough Express